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spk10: Greetings, and welcome to the DocGo third quarter 2023 earnings conference call. At this time, all participants are in listen-only mode. A brief question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star and then zero on your telephone keypad. As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Mike Cole, Director of Investor Relations. Thank you, sir. Please go ahead.
spk08: Thank you, operator. Before turning the call over to management, I would like to make the following remarks concerning forward-looking statements. All statements made in this conference call, other than statements of historical fact, are forward-looking statements. The words may, will, plan, potential, could, goal, outlook, design, anticipate, aim, believe, estimate, expect, intend, guidance, confidence, target, project, and other similar expressions may be used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance, and we cannot assure you that we will achieve or realize our plans, intentions, outcomes, results, or expectations. Forward-looking statements are inherently subject to substantial risks, uncertainties, and assumptions, many of which are beyond our control and may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward-looking statements. These risks, uncertainties, and assumptions include but are not limited to those discussed in our risk factors and elsewhere in DOCCO's annual report on Form 10-K, quarterly reports on Form 10-Q, and other reports and statements filed by DOCCO with the FCC to which your attention is directed. Actual outcomes and results or the timing of results or outcomes may differ materially from what is expressed or implied by these forward-looking statements. In addition, today's call contains references to non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are provided directly as part of this call or included in our earnings release, which is posted on our website, dot go dot com, as well as filed with the Securities and Exchange Commission. The information contained in this call is accurate as of only the date discussed. Investors should not assume that statements will remain relevant and operative at a later time. We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events, except as to the extent required by law. At this time, it is now my pleasure to turn the call over to Mr. Lee Bienstock, CEO of DOTCO. Lee, please go ahead.
spk07: Thank you, Mike, and thank you all for joining us today. The third quarter marked our strongest growth since inception. and I'm extremely proud of the focus our team has brought to expanding our suite of services, our operational execution, and our financial performance. Both during the quarter and subsequent to quarter end, we continue to expand with our current customers while also signing new customers and winning RFPs. Most importantly, our team continues to strive to increase access to care for those who need it most. During the third quarter, we surpassed 7.5 million total patient interactions since inception, while leveraging a workforce that has now grown to over 6,000, more than double since I joined the company. Our services are in strong demand across the board. And as a result, we are increasing our full year 2023 revenue guidance to 615 to 625 million, up from 540 to $550 million. And we are increasing our full year 2023 adjusted EBITDA guidance to 50 to 55 million, up from 48 to 53 million. While our migrant work has received much of the media attention in Q3, it barely scratches the surface of what DOTCO accomplished last quarter. To give a sense of the full picture, in Q3 alone, DOTCO transported over 158,000 patients Our patient engagement team conducted outreach to over 50,000 patients. We provided RPM, VCM, and CIED monitoring for over 46,000 patients and increased our staffing headcount by over 26% during the quarter due to increased demand for our services. We also increased our clinical capabilities to close over 30 different care gaps in patients' homes, including bone density measurements, colon cancer screenings, diabetic retinal screenings, and annual wellness visits. DOTCO is bringing care to patients where and when they need it, and we are gratified to see that many of our customers recognize the value of our services and routinely expand our assignments. I'm excited by all our efforts to serve patients with our insurance partners, government and municipal population health programs, and hospital system customers. I'd like to share our impact, progress, and future opportunities across all three of these key areas. First, with our insurance partners and at-risk provider groups, the market opportunity with major insurance companies and value-based care partners, like the deals we've signed with healthcare partners, Emblem Health, and others, is one area where we have made great progress. We entered this space with pilot programs late last year, and the majority of those partnerships we've launched have expanded over the past six months. driving more expansive commercial rollouts. Last quarter, we announced that we expected to be assigned 73,000 patients to close care gaps and provide primary care services under these agreements with four payers. We have already been assigned 59,000 of these patients and have expanded our clinical offerings to encompass a wide range of primary care services, including annual wellness visits for Medicare members and pediatric checkups, including childhood vaccinations and nutritional counseling Medicaid members. We expect strong growth in the number of patients assigned and view this as a significant opportunity for DACO with years of growth potential ahead. In our population health programs, our work with migrant related services has continued to grow substantially during the quarter and we've launched four new sites in the last six weeks alone. We expect to continue to work closely with our partners at the city and to provide asylum seekers with the medical care, behavioral health care, basic necessities, and support services to help transition them out of the program and into a position of self-sustainability as quickly as possible. Contrary to early negative media, we recently shared that the contract has been registered and payments have commenced. In addition, a recent independent report by the New York State Office of Temporary and Disability Assistance found that our programs were working as planned and asylee needs are being met. We believe this report accurately reflects DACO's efforts and program quality, as well as our commitment, diligence, and dedication to helping to improve the health, safety, and overall well-being of all those in our care. Submissions for municipal and corporate RFPs remains a core focus and a material opportunity for the company. We recently learned that we were not awarded a large federal border patrol RFP, but we have many other opportunities we are excited about. Going forward, we intend to speak about this channel as a portfolio of opportunities without as much granular detail on any one specific RFP. We intend to pursue mobile health, both medical and behavioral health, medical transportation and municipal opportunities both within our current footprint and with an eye towards expanding into new states, all aligned with our growing skill set. For our partners with hospital systems and medical transportation, we are also seeing substantial new contract wins. To share a few, we recently announced our contract with Mainline Health Systems in the Northeast, which we expect to represent approximately $23.5 million in revenue potential over three years. And we have plans to further grow this relationship in early 2024. Additionally, we want a large medical transportation contract valued at $34 million over the next five years in the UK. And our large New York health and hospitals contract we announced early this year is now fully rolled out as planned. We are very pleased with how this segment is performing and expect to see continued strong organic growth in the coming quarters. At this time, I'll hand it over to Norm to cover the financials. Norm, please go ahead.
spk09: Thank you, Lee, and good afternoon. Total revenue for the third quarter of 2023 amounted to a company record of $186.6 million, which was 49% higher than our last record set just a quarter ago in Q2, and it represented a 79% increase from the third quarter of 2022. Mobile health revenue for the third quarter of 2023 was $139.3 million, up 74% from the second quarter and 82% higher than last year's third quarter. While most of the revenue gains were related to the expansion of our migrant services contracts, we experienced growth across several projects. Some of our migrant services programs include the provision of what we call total care services, which includes shelter and related items in addition to core medical services. These non-medical services are expected to account for a smaller proportion of DACA's overall revenue base in future quarters, as our newly awarded or launched contracts tend to be more focused on medical-related services. Transportation services revenue increased to $47.2 million in Q3 of 2023, up 4% from the second quarter of this year, and more than 70% higher than transportation revenues in the third quarter of 2022. Nearly every core transportation market witnessed year-over-year revenue growth, continuing the momentum that began in the second half of last year. In the third quarter, mobile health revenues accounted for approximately 75% of total revenues, and transportation was approximately 25%. This breakdown is closer to our expected mix of revenues than what we have seen in the prior three quarters. Based upon early indications in Q4, it appears that mobile health will likely continue to account for over 75% of total revenues in the fourth quarter of this year. As of the end of the third quarter, our revenue backlog, defined as remaining revenue from projects that have been awarded but have not yet been fully rolled out, stood at $430 million, up from $325 million at the end of Q2. We recorded net income of approximately $4.6 million in Q3 of 2023, compared with net income of $1.3 million in the second quarter and net income of $2.5 million in the third quarter of 2022. Adjusted EBITDA for the third quarter of 2023 amounted to $16.7 million, up 84% from adjusted EBITDA of $9.1 million in the second quarter and nearly doubled the $8.4 million in last year's third quarter. The adjusted EBITDA margin in Q3 was 9%, compared to 7.3% in the second quarter and 8.1% in the third quarter of 2022. Total gross margin percentage during the third quarter of 2023 was 29.5%, down from 33.4% in the second quarter and 31.7% in the third quarter of 2022. Growth margins in the third quarter were negatively impacted by the increase in revenues and the associated project ramp-up costs that resulted from the recent launch and ramp-up of new projects. As previously discussed, our revenue increased approximately $60 million just since the end of the second quarter. We took the opportunities that were presented to accelerate our growth with the anticipated trade-off of temporarily lower gross margins. While we had previously anticipated that gross margins would continue to improve sequentially throughout 2023, we had indicated that overall margins could be impacted by the timing and size of newly launched and ramped up projects. This is exactly what occurred in the third quarter of 2023. However, it is worth noting that gross margins were still more than 100 basis points higher than the recent low point of the first quarter of this year. Specifically, when we witness accelerated revenue growth, we tend to see higher than normal labor costs due to higher than planned overtime rates and a greater dependence on relatively more expensive subcontracted labor. During Q3, our company-wide overtime rate was 17%, well above our targeted rate of 5% to 10%. Subcontracted employees accounted for close to 50% of total field labor costs. We typically aim for this number to be closer to the 25% area. During the third quarter, gross margins from the mobile health segment were 28.8% compared to 34.9% in the second quarter and 34.8% in the third quarter of 2022. In the transportation segment, gross margins expanded for the fifth consecutive quarter, increasing to 31.7% in Q3 of 2023, up from 30.7% in the second quarter and 23.2% in Q3 of 2022. Looking at operating costs. Operating expenses as a percentage of total revenues amounted to 24.8% in the third quarter of 2023, down significantly from 32.1% in the second quarter and compared to 27.7% in the third quarter of 2022. Looking at the same comparison without depreciation and stock comp expenses, operating expenses as a percentage of total revenues amounted to 20.7% in the third quarter of 2023, down from 26.4% in the second quarter and 23.7% in the third quarter of 2022. As revenues have increased, we have seen operating expenses decline as a percentage of total revenues, leading to operating margin expansion. therefore despite the lower gross margins adjusted ebitda margins were higher in q3 than in either q2 or q3 of last year as i mentioned earlier now turning to the balance sheet as of september 30 2023 our total cash and cash equivalents including restricted cash was 67.3 million dollars as compared to 123.8 million as of the end of q2 the decline in the cash balance is primarily related to an increase in our accounts receivable, reflecting the increase in revenues in Q3, which was on top of the sequential growth in revenues in Q2. This revenue increase was primarily driven by our government business, including our micro-related work, which features a lengthy initial payment cycle. However, since the end of the third quarter, we have now begun to receive payments for this work performed, And as we reduce these accounts receivable, we expect near-term collections to be enough to drive our total cash balance higher in subsequent periods, despite our ongoing working capital needs. In order to bolster our working capital, subsequent to quarter end, we drew down on a revolving credit facility in the amount of $25 million. This leaves us with another $65 million in available credit. We view this credit as being short-term in nature. As our largest outstanding invoices are paid back, we plan to pay down the amounts outstanding. However, we do expect the recent working capital demands to persist as we stay in growth mode with an increasing payroll and as we are paying sizable invoices to our vendors, all well in advance of receiving payments from these customers. Turning to our outlook for the remainder of 2023, we anticipate continued strong demand from our customers for both mobile health and transportation services. We're very encouraged by our performance so far in Q4. And so far, early indications reflect that we have carried over the revenue momentum from Q3, wherein we witnessed higher monthly revenues and expanded margins throughout each month of the third quarter. While revenues in Q3 were much higher than initially anticipated, we view this outperformance as an acceleration, not as an aberration. During Q3, we got to a point on our growth curve that we had originally assumed was at least another quarter or two out. But we do not believe that this is one-time revenue. As such, as Lee mentioned earlier, we are raising our revenue guidance for the full year, 2023, and we now expect that revenues will be in the range of $615 million to $625 million, compared with our most recent increase in revenue guidance into the $540 million to $550 million range. The original revenue guidance for 2023, I'll remind everyone, was $500 million to $510 million. The increased revenue guidance range would represent year-over-year top-line growth of about 40% on an as-reported basis. However, when removing the $75 million of mass COVID testing from our 2022 revenue baseline and considering that we have not received any material mass COVID testing revenues thus far in 2023, then we would expect to be looking at top-line growth of nearly 70% when comparing full year 2023 with full year 2022. We are also increasing our guidance for adjusted EBITDA into the range of $50 million to $55 million from our recent guidance of $48 million to $53 million, which had already been raised last quarter from our initial 2023 guidance range of $45 million to $50 million. With respect to 2024, it's too early for me to provide any specific details at this time. However, we expect a strong finish to 2023, which is implied by our guidance, and we believe that our backlog numbers gives us solid visibility into continued growth in 2024. At this point, I'd like to turn the call back over to Lee.
spk11: Thank you, Norm.
spk07: My goal as CEO is to usher in a new era of operational excellence, maturity, and vision as DACO becomes laser-focused on what I consider to be our three greatest growth opportunities. My vision for the future of our company is clear. We help our three customer verticals, health systems, municipalities, and insurers keep patients out of the hospital. First, as I mentioned at the top, care gap closure and additional opportunities with major insurance companies and value-based care provider groups. The early data points are exciting, and we are working on numerous opportunities that we expect to expand our number of assigned patients, our geographical presence, and scope of services. Our remote patient monitoring and chronic care management solutions fall under this effort as well. We believe our in-home and virtual medical visits combined with remote monitoring and care management allows us to successfully care for some of the most complex patients which drive the highest costs. We intend to bring this capability to our health plan partners with innovative programs where we can potentially share in the savings we deliver. Second, readmission avoidance programs with major hospital systems. These programs have historically yielded strong results for our customers, and we intend to aggressively pursue growth opportunities in this vertical. And lastly, continued emphasis on our RFP channel and what we believe to be large market opportunities. We have made great strides in the last year, enhancing our overall ability to identify and compete for these types of projects, and we expect to continue winning larger and larger contracts over time. The common thread in those three markets is that we have the customer data to support the value proposition that DACO offers. Now we just have to go out and grow it, and we are going to focus on doing exactly that. We believe we have multiple greenfield opportunities in front of us within the three verticals I've mentioned throughout this call. And my goal as CEO is to lay the foundation for significant growth at DACO for many years to come. At this time, I'll hand it over to the operator to open up Q&A.
spk11: Operator, please go ahead.
spk10: Thank you, Seb. We will now be conducting a question and answer session If you would like to ask a question, please press star and then 1 on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star and then 2 if you would like to remove your question from the queue. Please note, participants are limited to one question and one follow-up at a time. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. The first question we have comes from Sarah James from Council Fitzgerald.
spk11: Please go ahead. Sarah, please go ahead.
spk05: Sorry about that. I wanted to circle back to Norm's comments on operating expense ratio. I appreciate the comments on scale, but I wanted to understand if this implies this is the new run rate or if there are other moving pieces like timing of investment spend that benefited the quarter?
spk09: Sure, Sarah. I would say that predominantly what you saw during the quarter reflects the new run rate, meaning given that we would expect that revenues would stay at this level or grow from this level, this becomes our new revenue baseline. We don't see anything that really is going to drive SG&A substantially higher other than obviously the typical normal increases that you would see from quarter to quarter as we continue to build out our infrastructure. Because remember, we're catching up. Now we're a $186 million revenue company in a quarter. So you're dealing with now almost a $725, $750 million annual run rate of revenue. And we've always been in a position where we have to allow our infrastructure to sort of catch up. But other than that, there's nothing specific that we can look at. There's no big marketing program that's on the horizon or anything like that that's out of the ordinary. So we would anticipate that we'd probably be able to stay at these kinds of ratios. I would just caution that it's not something that continues to go. We're not going to get to a point where SG&A is going to be 10% of revenue. There's likely a point at which there's a step function of SG&A. But otherwise, you should be able to see the same kind of leverage in coming quarters as what you saw in Q3.
spk05: Great. And then one more. You guys mentioned that payments are being made on New York HPD. Can you give us a sense of where cash or receivables sit on that now that we're through October? Is it still lagged versus a normal contract, or are you guys all caught up?
spk11: Yeah. Hi, Sarah. It's Lee.
spk09: I think we're still catching up a little bit. I think there are a couple of things to look at when we talk about a lag, though. There's looking at the invoices from the date of service. to where we are today, in which case I would say that's a little bit more of a lag than what we typically see. But the real factor there is when the contract gets registered. For all of these municipal contracts, and this is why, you know, we made such a big deal about the contract being registered. That's why we mentioned it in an 8K. No contract, even if it's fully signed, no contract is paid for until or the services are not paid for until the contract is registered. Thankfully, this contract has been registered. When I look at where we are in the payment cycle vis-a-vis the registering of the contract, then, you know, we're fully within the typical range of what we've seen across different municipal agencies and a bunch of different municipalities. You know, we've been in the municipal business for, you know, three and a half years now. So none of that is out of the ordinary. It's just that it's a very big number.
spk10: Thank you.
spk07: Yes. And Sarah, the only thing to add there, as Norm was saying, I think our experience has been this, where we go back and forth with the invoice and get the invoice in the right cadence, the way the municipalities like to see it, and then payments happen in a fairly regular fashion from there on. So pretty indicative of where we've been in previous contracts. Same here, but as Norm says, it's a larger number this time around.
spk11: Thank you, Sal.
spk10: The next question we have comes from Richard Close from Tenacore Genuity. Please go ahead.
spk01: Thanks for the question. Maybe just to follow up on that, Norm, can you just sort of walk us through your thoughts on accounts receivable and how we should think about that number in the fourth quarter and I know you're not given 2024 guidance, but just sort of the trajectory of that number.
spk09: Yeah, sure, Richard. And let me take the opportunity to give you insight into how we look at managing our AR portfolio from the top down. So if you look at the number itself, it's a very, very large number, right? We're over $200 million in AR now. If you look at it from, there are two different ways of looking at it, obviously. So you can look at it in terms of day sales outstanding. Now it's over $200 million of AR, but now we're at a point where we're doing close to $200 million, 186, almost $190 million in quarterly revenue. So in terms of just a raw calculation of day sales outstanding, while it's higher than it was at, let's say, the last quarter end at 630, it's actually lower than it was at March of 2023. So that's a little something to take into account. It's still a number that's very large. And the thing that we look at is across the different buckets, the different aging buckets of our accounts receivable is whether or not we've seen any deterioration in our portfolio. And thankfully, we have not. We actually spent, you know, sort of behind the headlines or underneath the headlines, we actually did very well in collecting some of our relatively aged receivables during this quarter, both on the transportation side of mobile health. The next thing that we like to look at is the makeup of the portfolio in those different buckets. So when I look at what is current, right, which is typically defined as zero to 30 days. So at March, just to give you a little bit of a baseline or, you know, a comparison, at the end of the first quarter, only about 25%, 26%. of our AR portfolio was under 30 days. As of June 30th, that number was about 56%. And now, because of the fact, obviously, it's sort of the way the map works, because of the fact that so much of this revenue is stuff that happened during this quarter, as of September 30th, nearly two-thirds, about 63, 64% of our AR is current. Also, when I look at the other side of the equation, when I look at the over 90, it's a lower number than what we've seen. When I look at over 180, you know, maybe 10%. And I will say in this business, especially on the ambulance side, we still collect quite a bit of what's over 180 days old. We often will collect things even out to 360 and plus. So I guess my summary of the answer there is that the AR is very, very large. We would expect it to start to come down because we would expect to get on a better payment schedule, let's say, with some of our larger customers like HPD or other municipal. But at the same time, we're growing revenues by quite a bit, so that's going to continue to put pressure on the overall number. But the thing that we look at most closely is how the buckets break down, and that's being pretty well managed.
spk01: Okay, thank you. And I guess on a follow-up, if we can just sort of – look at the gross profit margin and just go into maybe a little bit more detail on your comments there and thought process of that number going forward.
spk09: So, yeah, sure. I mean, as I mentioned in my prepared remarks, you know, over the last couple of quarters, we've talked quite a bit about how it was our expectation that margins would grow sequentially as we went through the quarters. We had 28.1% gross margin in Q1. I think I went to 33.4 or something along those lines in the last quarter, and now we're taking a step back. But what we had always maintained was that that was assuming that the growth was happening at a pretty steady state. And what you saw this past quarter was a good bit more revenue than I think what we had anticipated a few months ago when we talked about, you know, growing that revenue on a – growing that gross margin on a sequential basis. And when we look at it, you know, there's no one particular project that is – you know, we don't – we haven't replaced high margin revenue with low margin revenue. There's none of that going on. It's really all in the areas of labor, which is both subcontracted labor percentage being higher than it would typically be, overtime being higher than it would typically be. The good news there is that those metrics, those KPI, which lead to the margins, improved sequentially as we went through the quarter. So it was at a certain level in July. It approved in August and approved again in September. So those are the things that are driving it. And, you know, anytime you're going to add new product, new project launches, and therefore a lot of revenue in a one particular quarter, that's going to be the pressure that you have. Having said that, without pinning down what I think Q4 gross margins will be, I will say that directionally, margins are higher than what you see this quarter. What you see this quarter, on the one hand, when it comes to revenue, that becomes our new revenue baseline off of which we think we can build. This is not any really non-recurring revenue in the quarter. This is real recurring revenue. On the other hand, when you look at the gross margin number, I would say that that was something that was temporarily lower than it really ought to be It's not our run rate of gross margin. It's not the run rate of gross margin that we saw leading out of the quarter. So if I would typically take the September month margin and apply that to Q4, that in and of itself would account for a higher gross margin. So that sort of plays into our expectation for the fourth quarter.
spk11: Thank you, Sobh.
spk10: The next question we have comes from David Lawson from BTIG. Please go ahead.
spk04: Hi, congratulations on the good quarter. Can you maybe talk a little bit about your relationship with the city and the state of New York and that contract itself? Can you just sort of refresh us on what exactly it is you're doing for the migrants? How many of these migrants are families with the children that you're serving? And then it's my understanding that the way the contract stands right now, it's about a one-year contract through mid-2024. You know, what are the odds in your view of it potentially extending? And then just lastly, and I'm sorry for the long question, have you been able to meet with the comptroller of New York? And I think he's had some concerns on the detail of the invoices. Have you been able to address his concerns? I'm in an airport. Sorry for the background noise. Thank you.
spk07: No problem. Thanks, David. So I'll start with the first part of your question, our relationship with the city. So we've been working with the city, as was mentioned, for over three years. We've been working on various different population health programs. We actually also provide, as I mentioned, the medical transportation for all 11 public New York City health and hospitals locations. We've been working with the city for a number of different years. You've heard us talk about the SHO program, which is the Street Health Outreach and Wellness Program. You've heard us talk about our work with the Department of Homeless Services. You've heard us now talk about our work with Housing Preservation and Development. You've heard us talk about our work with New York City Health and Hospitals. So we've been helping New York City across a wide range of population health and medical transportation needs since we started working with the city over three years ago. and we've provided care to millions of New Yorkers together. We're very, very proud of that. In terms of the asylum seeker and migrant care work, it actually all started with the first buses arriving at Port Authority, and we actually provided the initial paramedic units at the Port Authority when the first buses started arriving from our southern border. That's really how our work together started. We provided the paramedic teams and we're doing health screenings infectious disease screenings and so forth you know for these sound seekers as they're arriving and it's essentially grown from there to all the services that we've been talking about and really it's grown to what we call our total care services and ranges from medical care that could be infectious disease screenings, urgent care, and other medical care vaccinations as well. It encompasses behavioral health, which includes depression screening and other case management work and intensive social work as well. And it encompasses, obviously, the other facets of the program in order to provide the total care that asylum seekers need when they're arriving, all with the goal to help them land safely and then ultimately acclimate and what we say graduate out of the program. So those are the services we've been providing. The different sites have a different composition of services, but those are the comprehensive suite of services that we've been providing. You asked about what percentage are families arriving with children. It's actually a large majority of the asylum seekers in our care are families with children composition. Most of the sites are families with children. And so we're providing services from ages two and pediatric care and up all the way to as old as 80 years old, we've been providing services. So the large majority are families with children. You asked also, David, about the length of the contract. As you alluded, the contract, the HPD contract is for the asylum seeker work we're doing is a year long, which is actually fairly customary for our contracts with the city. Many of them have been extended. Many of them have been re-awarded. We do fully anticipate that portions will be put out for RFP and so forth, which is very, very customary to how we've been working with the city now for over three years, as I mentioned. That contract with HPD was signed and initiated in May, and so if you follow that year-long chronology, you would have it until May of next year. But again, really our goal is to provide the services that the city needs, the medical care and the behavioral health care that the city needs for as long as the city may need it. And our goal is to help the city in aiding the asylum seekers so that they can essentially live their lives, acclimate out of the program, and receive the services that they need for however long as the city asks us to provide or for however long the asylum seekers need it.
spk11: Thank you.
spk10: So the next question we have comes from Mike Latimer from Northland Capital Markets. Please go ahead.
spk03: Great. Thanks. Yeah. Congrats on the phenomenal revenue EBITDA growth here. I guess just back on the cash position for a second, maybe just trying to see if we could bracket that a little more. I mean, do you think that cash flow from operations might be, you know, above or below EBITDA? in the fourth quarter, and then kind of by year end, you know, what months do you think you'll get paid up to by year end?
spk09: Yeah, so, hey, Mike, this is Norm. I'll take that one. And just this allows me to make a point that unlike previous quarters, we filed our 10-Q for the quarter already. We did that pretty much concurrently with the earnings release. So, well, a lot of that information is in the release anyway, but that, you know, more detailed information is currently available. So as far as the cash flow from operations as it compares to EBITDA, so one thing that you'll notice is that the impacts that you saw in operating cash flow were entirely from the working capital side. Otherwise, in terms of what we like to call the P&L situation, operating cash flow, that number was already pretty close to resembling the EBITDA number. I guess the question is when we're going to get to a point where working capital is no longer a drag on the operating cash flow. So it might happen in Q4. Frankly, it's really going to depend on the timing of when we get specific payments in here compared to how quickly we grow and how our expense base grows because we're laying out the money in effect for labor, for a lot of other things to our vendors in advance of when we get paid by the city. So we have that ongoing negative cash cycle as far as those programs go, whether it's the city or whether some of our larger municipal or other customers. So I would expect that we're sitting here early November. We've got about... You know, is it six weeks, six, seven weeks at the end of the year? You know, it's our expectation that we would be pretty well caught up by the end of the year. At least that's our hope. It's just something that is somewhat unpredictable given that, you know, we're not the ones who actually pay ourselves. And, you know, we are in discussion with the different finance departments, the different relevant finance departments on a daily, on a more than daily basis at a bunch of different levels, whether it's me, whether it's Lee, whether it's people within our finance or operating teams. So there's a lot of dialoguing going on. I should point out, and this sort of ties a little bit to something that I think David mentioned in the question just before yours, which is any of the slowdown in the payment is not – none of the slowdown in the payment is related in any way, shape, or form to disputes. Nothing is being disputed in terms of the amounts that we're charging, in terms of the categories for which we're charging. It's simply a matter from time to time of asking for more backup. Which which we have and which we just have to send over their way. I think once we get on a pretty good cadence with them in a good payment rhythm with them, we will, we will catch up pretty quickly. The schedule that we, I'm not going to share the specific details, but we have shared a schedule with the city. that lays out when we would expect to get paid. And if they do keep it to that schedule on a month-by-month basis, on a monthly invoice-by-monthly invoice basis, we would be largely caught up by the end of the year with your typical, I'll say, 60-day, 60- to 90-day lag from when the services are provided, which is normal for all of our contracts. So that would obviously have a big impact on what we see in Q4. I'm just a little bit loathe to make an estimate as to where the balance sheet is going to be come year end because there's just a lot of things that could move in that direction. And what I would look for is just sort of an improvement, a reduction that they say is sales outstanding and other metrics that would indicate on the operating cash flow side that we're starting to catch up.
spk03: Okay, great. Thanks. And then in the second quarter, I know you signed up a select group of staffing agencies to, you know, contracts that were meant to, you know, maybe give them some more volume, but also under favorable terms. Can you tell, and I know this quarter you've ramped up really quickly on this new deal, but can you tell us those, you know, contracts and the staffing agency relationships and the terms, are they all being kind of met as expected, you know, I guess factoring in this kind of rapid growth issue?
spk11: Yeah, so Mike, absolutely.
spk07: So we're actually utilizing all of those contracts in full effect in Q2, Q3, and beyond. All of those partners, we call them partners because they're helping us scale tremendously. All of those partners, all of those contracts are performing as expected. All of the negotiations and structuring of those contracts are actually well done and And so, yes, we're absolutely benefiting greatly from those in Q2 and Q3 and going through the rest of the year here.
spk10: Thank you. The next question we have comes from David Grossman from Stifle. Please go ahead.
spk06: Thank you. Good afternoon. I'm wondering, Lee, you spoke a little bit about your commercial business and your prepared remarks and It sounds like you're still at 73,000 lives with four pairs with roughly 68,000 lives assigned as of, I guess, now. Can you give us any better insight into how these pilots should ramp from a revenue perspective over the next 12 months and any new business that may be in the pipeline to give us a sense of just how this business should scale over the next year or so?
spk07: Yeah, absolutely, David. Happy to do so. So I think we look at that business, we look at a multitude of different metrics. The first is, as you mentioned, the number of patients that are being assigned to us. That number, I'd like to see that number growing. It is growing. It's growing very much so, and so we'd like to see continued growth there. From there, I tracked And our team tracks sort of conversions. How many of those patients do we engage? Do we engage? Do we go and provide the care gap, go into the home? And I'd like to see that number is going to also increase over time as our teams get more and more specialized, more and more trained, as we get more and more experience, and as we bring on more and more talent to our team. That number has also been going up. In fact, last week I was looking at a metric where I saw the highest conversion since we started. So that metric I'd like to see going up, and it is going up, and I'm pleased with our progress there in terms of how many of the patients that are assigned to us engage with us. And obviously, we have a unique model where we don't call the patients who come into our office, but rather we go to their home. And obviously, we are able to decrease the barriers of access and bring care to the patients that need it. Almost all of these patients have not seen their primary care provider in over a year, and many of them are chronically ill. Almost all of them are chronically ill. and so are in need of care gaps, are in need of intervention, are in need of our services. So I look at assigned patients. I look at conversions. The other thing I look at, which I'm very pleased with and I mentioned on the call, is the number of care gaps, the breadth of services that we're offering. And we feel like this is a very big, an additional competitive advantage for us. Obviously, the mobile delivery is a competitive advantage, and our broad service set of care gaps is also a competitive advantage we get a lot of market feedback that what we're offering the breadth of our services is actually pretty unique as well and so i'd like to see us offer more and more and more care gaps more and more clinical services to more and more chronically ill patients who need it and as we see that we see our health plan partners relying on us and partnering with us more and more and we're assigning us more patients and as we scale that so those are the metrics at a high level that we look like that we look at We look at a lot more in depth, but I'm looking forward to sharing on these calls our progress on how many patients, the continued growth of the number of patients that were being assigned, but also how many were engaging, how many were enrolling in our remote patient monitoring and virtual care platform, how many were doing cardiac monitoring for, how many care gaps were closing, and ultimately the contracts we have can evolve into us becoming the primary care provider of record. to us potentially sharing in the cost savings, in the value-based arrangements and value-based care. So a lot of runway for us in this segment. We're very excited about it. And we're also doing a lot of tremendous good for the patients that we go and see that we're closing significant care gaps and likely catching sort of catastrophic, potentially catastrophic episodes before before they become so like our diabetic retinal exams are catching blindness potential blindness or potential vision impairment before it happens as an example so and that obviously becomes costly and is a horrible outcome for a patient so we're very very pleased with the momentum with the metrics we're pleased with the great care we're providing with the good we're doing for the patients and so we think there's a lot of runway and a lot of growth and a lot of good to be done in the coming quarters, and I'm looking forward to sharing that progress as we expand.
spk06: Right, so perhaps it's too early, but is there anything you can do to dimension kind of what's going on, whether it be pipeline in terms of lives or any other quantitative metrics that may give us a better sense of how this business is scaling?
spk07: Yeah, we'll share out how many, as the number of lives and number of assigned patients get assigned to us, we'll share out. The partners we have collectively have millions of lives to be assigned to close care gaps. And we're, in my opinion, only scratching the surface of what could be done. We need to scale the effort. We need to scale our patient engagement team. We have to continue to scale our team in the field. We continue already to invest significantly in our technology platform and our clinicians. So we can continue to invest there. And I can tell you that the partners we have have many hundreds of thousands of patients each, a million plus patients as we consider the larger partners we have. So we are sort of scratching the surface of the good we could be doing there. And I think it's too early to say exactly the various metrics throughout that funnel I just described, but we definitely will be sharing that in the coming quarters.
spk11: Thank you.
spk10: The next question we have comes from Ryan McDonald from Needham & Co. Please go ahead.
spk02: Hi, thanks for taking my questions and congrats on a nice quarter. Lee, I appreciated the commentary and sort of the outline of the strategic vision here and sort of the three key areas you're focused with in terms of insurance partners, you know, municipalities and health systems. As you look at sort of time allocation and where you see the biggest opportunity, how would you rank those three opportunities in terms of you know, potential pipeline or backlog generation moving forward?
spk07: Yeah, so thanks, Ryan, for the question. Not sure I'll rank the customer segments because we love them all the same, so to speak, and we love all of our partners. And I would say, you know, when I look at it, obviously we shared the vast majority of the revenue is coming from health systems and municipalities today. But we see tremendous – our growth percentages are very, very large with the third segment. which is the value-based care insurer group. So we see, I'm not sure I'd stack rank one over the other because, again, our goal is to provide an absolute exceptional customer experience. It's part of our culture for every single customer we have. No matter how large, no matter how small, we give an absolute exceptional customer experience, which is the reason why they tend to grow with us and A small customer today could be a very large customer in the future. So that's the way we view it. I will say that we continue to submit proposals for all three. We have growth plans in place for all three. We are investing in growth in all three. And so I think you're seeing a lot of the large contract wins. To more address your question, we are seeing the large contract wins, the dollar value contract wins coming in the health systems, our hospital partners. municipalities the contracts that we are winning and negotiating and have in the pipeline with the insurers have the potential to be very large as we scale them and as we can take on more and more patients then we'll be able to they'll come with more associated revenue numbers and growth for them so we're going to be investing in that but the winds right now are coming in the dollar winds are coming in the first two I would say the expansion opportunities And the market potential is also coming in that third pillar with the insurance providers as well.
spk02: Super helpful. I appreciate the color on that. And then maybe as a follow-up, earlier this year at the Investor Day, you had kind of outlined a path to a 20% adjusted EBITDA margins exiting 25 that was underpinned really by a 40% gross margin profile. Given the success you continue to have on the top line and some of the temporary margin pressure that creates, Do you still view those 40% gross margin, 20% EBITDA margin targets as structurally achievable in the business today?
spk07: They are structurally achievable. Oh, go ahead. Let me just say, Norm, that they are structurally achievable, and they continue to be our goals, as we stated at the investor day. But, Norm, go ahead.
spk09: Yeah, that's pretty much how I was going to say it. Yeah, the way we sort of model that out is we have roughly 40%. roughly 40% gross margins on a blended basis, consolidated basis, and SG&A would be about another 20 points. We're kind of there on the SG&A with the understanding that we might take a step back before we take a step forward, but we're pretty close, where obviously we have more room to... to get to is on the is on the gross margin side but yeah we think structurally it is achievable uh and i'll just echo what lee said it's definitely our goal uh it's really going to be a matter of digesting some of these recent revenue gains and uh and then taking that number higher like we kind of know where we do it we kind of know where we do it and how we do it um it's just going to be a matter of the timing of that of that growth curve on the top line that's going to have an impact in the near term on how close we get to that number
spk11: Thank you.
spk10: So the next question we have comes from Peter chicken from Deutsche bank. Please go ahead.
spk12: Yeah. Good afternoon guys. So this model has evolved a few times in the last few years, you know, starting off, you know, with COVID and morphing into homelessness and then into the migrants, I guess, how should we think about both homeless and migrants as a growth engine for the next few years? And can you talk about who you're seeing as competition in those markets now? For example, for the border opportunity, what if the company won that contract?
spk07: Hi, Peter. I'll jump in. So it's still too early in terms of the border patrol contract. We'll find out in the coming weeks and months who ended up winning that. But I just want to really mention, start off by saying, in terms of that evolution that you described, we – Our whole business, all of our segments, all of our customer base, our markets, we're growing at the target rate we put out, even without the HPD asylum seeker contract. So that obviously has accelerated our growth, but we would still be growing at our target rate without that HPD contract. So I want to make sure that I shared that. And so I think in terms of the asylum seeker care, there's a lot of – there's a lot of transferable expertise that we've been bringing to that contract. So first off, there's a transportation component to that, and obviously one of the largest medical transportation providers in the country. We utilize that, as I mentioned, those first paramedic BLS units at the Port Authority were our transport teams. And we continue to use our platform to help the city scale the care for this particular population. We use the same logistics platform. We use the same tech platform. We use the same vaccine management platform. And we're growing every single day our capabilities that we're helping to provide the care for the asylum seekers. We're also using those same exact competencies for other contracts. As an example, you can imagine casework and behavioral health care that we're providing at scale for asylum seekers is also applicable to patients of insurance providers and some of our other key customers. So we continue to leverage the capabilities we have across all of our segments. There's a common thread for all of the customers we partner with, for all of the patients we're providing care. We leverage all the same platforms, all the same technology. And so that has allowed us to scale very, very rapidly. It's those investments in our people and our technology that have allowed us to do that. And we apply that to a myriad of different patient populations. And so I just want to make sure that I share that. And I think that's a very key aspect of our growth and how we've been able to provide care for such a wide swath of patient needs.
spk12: Okay. And then one more on the cash collections. I understand you're not guiding to a full recovery by the fourth quarter. But if you do sort of recover the cash or if you do sort of collect the cash in the fourth quarter, is it fair to think that you'll pay down the revolver that you drew on? And then looking actually at those delays, how much of that is due to sort of the real-time audit that's being conducted? You're very clear saying there weren't any disputes here. But when you are getting real-time audited, are you seeing any pushback from the state during that audit? I'm just thinking about, you know, the hotel rates, per diem food or accessing health care via telehealth or in person. Thanks so much.
spk09: So, you know, as far as the first part of your point, you know, I don't want to paint this into a corner. I mean, it would make a lot of sense for us as we generate this more working capital, this more free cash flow, for us to use that to pay down the credit line. I mean, the credit line is not being seen as – something that we want to have on a permanent basis, something that we have there to give us some flexibility. So, yeah, clearly we would pay that down as we could. As far as the other thing, in terms of the impact of the real-time audit, so here's where I think the impact comes in. I think it's a matter of the type of backup process. that is asked for on these invoices, and it's something that is being done in anticipation of the real-time audit. There hasn't been any other indirect impact of it. And that's kind of an impact that tends to wane after time because once we get to a good rhythm with them in terms of the types of backup that we're going to provide together with our invoices, then we just do it again and again as we go through the next month's invoice and the next month's invoice. So it hasn't really had a big impact. in terms of anything like that. It doesn't mean that they sit on every invoice for longer. It really just means that they will have some more requests for backup sort of upfront than what we otherwise would have expected to provide.
spk11: But that in and of itself is not really an issue for us. Thank you, Sal.
spk10: The last question we have comes from Richard Close of Camcord Genuity. Please go ahead.
spk01: Yeah, thanks for the follow-up. Just with respect to the backlog increase, and Lee, I appreciate your comments on the three channels, but is most of that increase in the backlog number that you provided, I guess the 105 million increase, is that pretty much evenly split between municipalities and the government channel? And than the health systems, or how should we think about that split?
spk09: So, Richard, I'll take that one. I've got the backlog file open in front of me here. And, again, just to refresh everybody's memory in terms of the way it works. So, all things being equal, the backlog number would go down as more of the backlog turns into actual revenue and quite a bit of it. Turned into actual revenue during this quarter. However, we're able to add quite a bit to the backlog based on different contracts that we've won really across our geographies and across our business lines. So I would say, especially this quarter, it's a really big mix. So you've got some of the government work that obviously is now on the table in terms of expansion or additional sites. That's clearly a big part of this. Uh, but at the same time, uh, there are a couple of contracts that we want in the UK that I think that we mentioned, um, where those are very large contracts that, um, are the kinds that will help us out. We have a couple with, um, uh you know native american populations you know other other types of projects that we do through one of our other entities uh so i mean this is this is stuff that applies to both the us it applies to the uk market it applies to mobile health it applies to transport it's actually really very very nicely spread out but without question without question a big part of it is is um is the fact that we do expect to to realize more revenue on some of the asylum projects given that given that we've seen it come in the way we saw it come in. But that's not by any measure, that's not an overwhelming drive of the backlog. Rather, the backlog is very diverse.
spk11: Thank you, Sal.
spk10: There are no further questions at this time. I would now like to turn the floor back over to Lee Bainstock for closing comments. Please go ahead.
spk11: Thank you. Thank you all for joining us today. Thank you all very much. Much appreciated. Speak soon.
spk10: Thank you. Ladies and gentlemen, that then concludes today's conference. Thank you for joining us. You may now disconnect your lines.
spk11: Well done, bud. My gosh, that was really good. All right, guys, I guess we got another call.
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